Medicaid Referral Forms

• Medicaid Referral Form - Blank

• Heather Mostella, CRNP

• Indu Prasadh, MD

• Katherine Dougherty-Basila, MD

• Tracy Bell, CRNP

Specialist Referral Forms

• ACHN Care Coordination - Fillable

• Allergy, Asthma, & Clinical Immunology - Huntsville

• Children's of Alabama - Fillable

• CRS - Gadsden - Fillable

• Masdon ENT - Fillable

• North Alabama ENT Associates - Fillable

• Silver Linings - Fillable

• Tennessee Valley Pediatric Surgery - Fillable

• Renew Family Dermatology - Fillable

• TOC

Requests for Medical Records

• HIPAA-Compliant Request for Medical Records - Fillable

Fax Cover Sheets

• SSP Fax Cover Sheet - Blank

• SSP Fax Cover Letter - Blank

• A Step Ahead Orthotics

• Alabama Ophthalmology Associates

• Alabama Psychiatry - Attalla

• Asthma, Allergy, Immunology - Dr. Raby

• Callahan Eye Clinic

• Carr Mental Wellness

• Clinic for Vision

• COA - Allergy/Immunology

• COA - Cardiology

• COA - Children's Behavioral Health

• COA - Dermatology

• COA - Endocrinology

• COA - ENT

• COA - General Surgery

• COA - Genetics

• COA - GI

• COA - Hematology/Oncology

• COA - Medical Records

• COA - Nephrology

• COA - Neurology

• COA - Neurology (South)

• COA - Neurosurgery

• COA - Orthopedics

• COA- Plastic Surgery

• COA - Pulmonary

• COA - Rheumatology

• COA - Sleep Medicine

• COA - Urology

• CRS - Gadsden

• Dermatology Specialists of Alabama

• Garrett Counseling

• Hanger Clinic Prosthetics & Orthotics

• Huntsville Hospital Imaging

• Little Critters Pediatric Dentistry

• Marshall ENT - Dr. Bray

• Marshall Therapy & Sports Rehab

• Masdon ENT

• North AL Community Care ACHN

• North Alabama Children's Specialists

• Northeast Orthopedics

• Orthopaedic Associates of Marshall - Dr. Kendra

• Pediatric Cardiology Associates - Dr. Israel

• Pediatric Dentistry East

• Pediatric Gastroenterology Associates

• Pediatric Therapy & Audiology - Huntsville

• Renew Family Dermatology

• Roy Sleep Medicine

• Sarrell Dental & Eye Center

• Silver Linings

• Southern Medical Equipment

• Sunny Horizons

• Surgical Associates of Marshall County

• The Eye Center

• Tennessee Valley Pediatric Surgery

• TOC

• The Pediatric Therapy Center

• UAB Pediatric Cardiology